American Exceptionalism—Excessive Death

 

The New York Times’ David Wallace-Wells published a newsletter¹ this week about excessive death in America. He cites, among various sources, a paper titled “Missing Americans: Early Death in the United States—1933–2021” by a team of mortality researchers. The data presented is both thorough and sobering. It shows that America is indeed exceptional, but in a manner no country would boast about.

The researchers compare mortality rates in America with the rates of our economic peers. After World War II, American death rates were lower than the other countries because many of them were still recovering from the war. In the 1960s and ’70s, there was relative parity, but beginning in the 1980s, the U.S. mortality rate began climbing relative to other developed nations. By 2000, about 400,000 more Americans were dying each year, and by 2010, it was nearly 500,000. In 2019, 622,000 more Americans died than would have if our death rate were similar to that of our peer nations. The pandemic, of course, widened the gap between the U.S. and the other countries. In 2020 and 2021, we had over a million unnecessary deaths each year. The researchers call these people “missing Americans,” individuals who wouldn’t have died if America could match the health outcomes of other advanced nations.

Wallace-Wells explores the reasons for this huge disparity. He mentions the “deaths of despair” among middle-aged white men, gun violence, drug overdoses, maternal mortality, and juvenile deaths, all problems that other nations don’t experience to nearly the degree that we do. For example, in 2020, the European Union, with a population of 440 million, experienced 5,800 total overdose deaths, while the U.S., with only three-quarters the population, reported 68,000 deaths, and that figure rose to 80,000 in 2021 and 107,000 in 2022.

Gun deaths, of course, are even more horrendous. According to the Institute for Health Metrics and Evaluation, the U.S. has 22 times as many gun homicides as the European Union. In 2021, the Economist, where my son is a researcher, reported 26,000 murders in the United States, compared with just 300 in Italy.

And we’re not just exceptionally violent. We’re exceptionally reckless. In 2021, the rate of car crashes in the U.S. were four times as high as in Germany. We had 5,000 workplace accidents, compared with just 123 in England. We were twice as likely to die in fires as Western Europeans and twice as likely to drown as the Dutch. Our cancer survival rates are the best in the world but we are twice as likely to have diabetes as the French and twice as likely to be obese as people in other OECD countries. Our maternal mortality rate is more than three times as high other wealthy nations.

Statistics show that our life expectancy trails almost all other advanced countries, and sometimes we think this is all about older citizens. But part of our life expectancy woes is due to deaths of young and middle-aged citizens. In 2019, for instance, the U.S. had almost twice as many deaths of kids under 15 than in similar countries. And we had 170,000 deaths among those between ages 15 and 44; if our rates were similar to other countries, we would have 100,000 fewer deaths.

Then there is Covid. Americans have died at a much higher rate than citizens of other countries. This is due to the strong anti-masking, anti-vaxxing sentiment that came from the politicizing of a public health crisis, something that didn’t happen in most other countries. Wallace-Wells points out that even though Covid is not entirely behind us (I caught it again two weeks ago), we are slowly returning to normal, but as he puts it, “It is worth remembering just what a return to normal means in this country: more than half a million extra deaths every single year and getting worse.”

One question we need to ask is why U.S. death rates started rising relative to other countries in the 1980s. A good possibility is the Reagan tax cuts and the implementation of supply-side economics, which planted the U.S. on a path of rapidly increasing inequality. As the lower levels of society (in terms of wealth) got left further and further behind, millions of Americans were without health insurance and therefore received inadequate care compared to all other advanced countries (and most Third World countries), where universal health care was the rule. Health costs in America also skyrocketed. In 1980, for instance, the average American spent $1,099 on health care. By 1995, that figure was $3,810. And costs have continued to rise far faster than inflation. In 2020, the average health-care cost per person in the U.S. was $12,530. Many people avoid going to the doctor or delay treatment for serious ailments because they either have no insurance or inadequate insurance. This certainly factors heavily in the excess deaths we experience in America.

The point of all this data is to show that America has some significant problems, many of them systemic, but many also due to our inability to learn from either our own mistakes or from other countries, who are outperforming us in so many ways. There are easy solutions to gun violence, for instance, and our health-care system is a total mess. We could improve our health outcomes drastically and cut our health-care spending perhaps in half just by adopting any of twenty health-care systems that have been proven effective in other countries.

Part of our problem is the fear of “socialism” that Republicans have drummed into their voters’ heads over the years. But socialism is not communism, and it offers better outcomes in so many ways than our blind devotion to our flawed version of capitalism. Government is not the enemy. It is our tool to serve our needs. The Republican hatred of government results not only in incompetent and ineffective government when the GOP is in control but also in shackled government when the GOP is the obstructionist opposition party. And I haven’t even mentioned the fact that Republicans are now making global warming a culture-war issue rather than a scientific issue to be dealt with in reasonable ways. How many people will die from climate-related disasters in coming years?

In so many ways, as I’ve explained on this blog before, the GOP is the pro-death party. It is only the GOP that is preventing us from adopting sensible policies that would prevent the huge difference between U.S. deaths and those in our peer nations. Oh, and did I mention that death rates are higher in red states than in blue states? This is a result not just of policies but of individual beliefs and attitudes. Republicans have boasted often about American exceptionalism, but as the data presented by Wallace-Wells indicate, our exceptionalism is nothing to write home about.

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1. See David Wallace-Wells, “Why Is America Such a Deadly Place?” August 9, 2023, New York Times, https://www.nytimes.com/2023/08/09/opinion/mortality-rate-pandemic.html?campaign_id=39&emc=edit_ty_20230810&instance_id=99719&nl=opinion-today&regi_id=93058658&segment_id=141618&te=1&user_id=b82adcd02b2fec762995462844df3be5.